ARUP Laboratories, Salt Lake City, UT, United States of America.
ARUP Laboratories, Salt Lake City, UT, United States of America; Department of Pathology, University of Utah, Salt Lake City, UT, United States of America.
Autoimmun Rev. 2022 Jun;21(6):103100. doi: 10.1016/j.autrev.2022.103100. Epub 2022 Apr 19.
To determine the impact of myeloperoxidase (MPO) and proteinase 3 (PR3) antigen-specific immunoassays in the stratification of patients at-risk for anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitides (AAV) at diagnosis.
A Medline search was conducted to identify diagnostic accuracy studies using PR3-ANCA or MPO-ANCA for the evaluation of granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA). Studies estimates were pooled using the bivariate method.
Diagnostic accuracy varied by analyte and AAV subtype. PR3-ANCA had greater sensitivity than MPO-ANCA for GPA (74% vs 11%, p < 0.001) and MPO-ANCA greater sensitivity for MPA (73% vs 7%, p < 0.001). Specificities of both MPO-ANCA and PR3-ANCA were consistently high (mean 97%, range: 93-99%) for both AAV subtypes. There was insufficient data to perform meta-analysis for the diagnostic accuracy of EPGA.
These results validate the use of high quality MPO-ANCA and PR3-ANCA immunoassays to screen patients at-risk for AAV as well as to categorize disease as GPA or MPA subtype. However, caution must be exercised in doing so, since some assays may not have optimal performance. Each laboratory should validate appropriate algorithms based on the tests used and testing population.
确定髓过氧化物酶（MPO）和蛋白酶 3（PR3）抗原特异性免疫测定在诊断时对抗中性粒细胞胞浆抗体（ANCA）相关性血管炎（AAV）高危患者进行分层的影响。
通过 Medline 搜索，确定使用 PR3-ANCA 或 MPO-ANCA 评估肉芽肿性多血管炎（GPA）、显微镜下多血管炎（MPA）和嗜酸性肉芽肿性多血管炎（EGPA）的诊断准确性研究。使用双变量法汇总研究估计值。
分析物和 AAV 亚型不同，诊断准确性也不同。PR3-ANCA 对 GPA 的敏感性高于 MPO-ANCA（74%对 11%，p<0.001），而 MPO-ANCA 对 MPA 的敏感性更高（73%对 7%，p<0.001）。两种 AAV 亚型的 MPO-ANCA 和 PR3-ANCA 的特异性均较高（平均值为 97%，范围为 93%-99%）。由于 EPGA 的诊断准确性数据不足，无法进行荟萃分析。
这些结果验证了高质量的 MPO-ANCA 和 PR3-ANCA 免疫测定可用于筛查 AAV 高危患者，并将疾病分类为 GPA 或 MPA 亚型。然而，在这样做时必须谨慎，因为有些检测可能性能不佳。每个实验室都应根据所用的检测和检测人群验证适当的算法。
